A machine learning approach for building an adaptive, real-time decision support system for emergency response to road traffic injuries.

In this paper, historical data about road traffic accidents are utilized to build a decision support system for emergency response to road traffic injuries in real-time. A cost-sensitive artificial neural network with a novel heuristic cost matrix has been used to build a classifier capable of predicting the injury severity of occupants involved in crashes. The proposed system was designed to be used by the medical services dispatchers to better assess the severity of road traffic injuries, and therefore to better decide the most appropriate emergency response. Taking into account that the nature of accidents may change over time due to several reasons, the system enables users to build an updated version of the prediction model based on the historical and newly reported accidents. A dataset of accidents that occurred over a 6-year period (2008-2013) has been used for demonstration purposes throughout this paper. The accuracy of the prediction model was 65%. The Area Under the Curve (AUC) showed that the generated classifier can reasonably predict the severity of road traffic injuries. Importantly, using the cost-sensitive learning technique, the predictor overcame the problem of imbalanced severity distributions which are inherent in traffic accident datasets.

Necrotizing fasciitis of the upper extremity: a retrospective analysis of 19 cases.

Necrotizing fasciitis (NF) is both a limb-and life-threatening disease that affects skin, hypodermis as well as superficial fascia and deep fascia by rapidly progressive necrosis. Although this serious infection frequently occurs in the extremities, upper limb NF is a rare clinical presentation. The present study attempted to evaluate the clinical profiles, paraclinical findings, treatment modalities, outcomes and predictors of morbidity and mortality in patients with NF of the upper extremity. The validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system was also assessed. Nineteen patients who were treated between January 2010 and December 2019 for NF of the upper extremity were eligible for this study. Data including demographics, clinical signs, paraclinical findings, treatment and outcomes were collected retrospectively from our medical records. Fisher's exact test was used to analyze predictive factors for mortality and morbidity. The mean age was 62 years, with a male predominance. The most common comorbidity was diabetes mellitus (42%). Main clinical manifestations were pain (79%), tense edema (79%) and a large infiltrated swollen erythematous plaque (58%). Severe sepsis and septic shock were identified in 32% and 21% of patients, respectively. Thirteen of our 19 patients (68%) were identified as having a high or intermediate likelihood of NF based of the LRINEC scoring system, while the other 6 (32%) were classified as having low likelihood. All patients received systemic broad spectrum antibiotic therapy in addition to surgical debridement. Two patients (10%) died and one (5%) required amputation. Mortality was associated with septic shock (p = 0.006), delay in surgery >24 h (p = 0.018), creatininemia >141 mmol/l (p = 0.018) and LRINEC score ≥ 8 (p = 0.035). Otherwise, anemia (p = 0.021), hypercreatininemia (p = 0.001) and delayed surgical debridement (p = 0.001) were risk factors for morbidity and mortality. The surviving patients underwent reconstructive surgery (skin grafting after wound preparation by using vacuum therapy) with positive outcome. Early diagnosis coupled with emergent surgical debridement and broad-spectrum empiric antibiotic therapy are the keystones of a successful outcome. The LRINEC score was not strongly correlated to the true diagnosis of NF and was a prognostic tool rather than a diagnostic one.

Floating thumb metacarpal in a motorcyclist: A case report.

We present a case of simultaneous dislocation of the carpometacarpal and the metacarpophalangeal joints of the thumb (floating thumb metacarpal) in a 47-year-old motorcyclist. The treatment consisted of closed reduction of both joints with cast immobilization. After 24 months, the functional result was excellent. The mechanism of this rare injury and its therapeutic management are discussed.

Which approach is best for subungual glomus tumors? Transungual with microsurgical dissection of the nail bed or periungual?

Glomus tumors are rare, accounting for 1% to 5% of all hand tumors. The treatment of subungual glomus tumors consists of complete surgical excision, either by the periungual or transungual approach. Tumor recurrence and nail dystrophy are the main complications. The purpose of this study was to evaluate the outcome as a function of the surgical approach used - transungual or periungual. Fifty-three patients presenting with a subungual glomus tumor underwent surgical excision through the periungual approach if the tumor was peripheral, or the transungual approach if the tumor was centrally located. These patients were followed for an average of 2years. Pain relief was always obtained the day following surgery. Wound healing was achieved on average after 2weeks with the periungual approach and 5weeks with the transungual approach. Other than some longitudinal striations in 10 patients (18.9%) who had been operated through the transungual approach, there were no complications or tumor recurrence. We recommend a periungual approach for a peripheral tumor and a transungual approach for a central tumor. The latter approach, which carries some risks of nail-related sequelae--always minor in our experience--allows for better exposure if the tumor is centrally located.

Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases.

Elbow dislocation associated with ipsilateral radial shaft fracture is an infrequent injury (nine cases reported in the literature). We present six new cases observed between 2006 and 2012, with an average age of 31 years and a mean follow-up of 18 months. The forearm fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. The dislocation was reduced by manipulation before open reduction and osteosynthesis of the forearm fracture. Four elbows were stable after reduction; two markedly unstable elbows necessitated temporary humero-ulnar external fixation; one case needed a ligamentoplasty several months later. Despite the complexity of the traumatic lesion, the clinical and radiological outcomes were acceptable.

[Myxoid neurofibroma of the thumb]. / Neurofibrome myxoïde du pouce.

UNLABELLED: Myxoid neurofibroma (MN) is a benign tumor of poorly identified perineural cell origin. We report a case of NM of left thumb and discuss the main differential diagnosis. CASE REPORT: A 34-year-old woman presented with a painless, slowly progressive tumor of the left thumb of 6 months duration. This tumor had recurred after resection done 26 years before. Clinical examination revealed a tumor on the anterior surface of the left thumb, painless, firm, 4×3cm, ulcerated and covered with thin telangiectasia. The X-ray of the phalanx showed no alteration to the underlying bone. The histopathological study of a skin biopsy reported a myxoid neurofibroma. Excision of the lesion was performed with preservation of the nail. Neither the patient nor her family members had neurofibromatosis. The outcome was favorable and no recurrence was noted after 18 months of follow-up. COMMENTS: The usual sites of the MN are the face, shoulders, arms, and periungual regions. It is usually a solitary lesion; however, lesions may be multiple or recur after initial incomplete excision as in our patient. It must be considered in the differential diagnosis of tumors of the extremities. We report this case because of the rarity of both the tumor and its site.

[How to avoid operative injury to Martin-Grüber communicating branch in the transmuscular medial approach of the elbow?]. / Comment éviter les lésions iatrogènes du rameau communicant médio-ulnaire de Martin-Grüber dans la voie d'abord transmusculaire médiale du coude ?

The incidence of Martin-Grüber medio-ulnar communicating branch (MUCB), from median nerve to ulnar nerve, is about 20%. To avoid operative injury to MUCB, the authors suggest some modifications to the medial approach of the elbow. They suggest medial aponeurotomy of the anterior compartment of the forearm, disinsertion of the medial epicondylar muscles with dissection between the flexor carpi ulnaris (FCU) and the other medial epicondylar muscles, not exceeding 3 cm distally. This allows a valuable exposure of the elbow joint through a medial approach, with FCU disinsertion and ulnar nerve transposition preserving the ulnar nerve vascularization, without injury to the MUCB.

[The digital external fixator, new equipment (24 cases report)]. / Le fixateur externe digital, nouveau matériel (à propos de 24 cas).

Phalangeal fractures and osteoarticular infections can be challenging injuries to manage, and their treatment is frequently complicated by deformity and stiffness. External fixation techniques have a well-established role in the treatment of these injuries. The mini-Hoffman external fixator is a particularly simple apparatus in design and in application. We report a technique of digital external fixator with a new original material developed in the service. It is an inexpensive and simple technique with good stability. The technical procedure is simple, consisting of two joints, Kirchner pins, 4mm diameter screwdrivers and a motor. Between 2001 and 2006, we used this method to treat 24 patients in a prospective study. The mean age was 35 years (range 16 to 68 years) with a male predominance, left hand predominance (14 cases), and carpenter's hand was the most frequent indication (11 cases). Mean duration of follow-up was two years (6 months to 5 years). Functional results were excellent in 12 cases and bad in six cases. Complications included a case of ischemic necrosis of the finger, two cases of secondary displacement, three cases of sepsis, two cases of algodystrophy and a case of pseudoarthrosis.

[Ewing's sarcoma of the hand: a case report]. / Sarcome d'Ewing de la main: a propos d'un cas.

Ewing's sarcoma of the hand is rare. This tumor was first described in 1921, since then, only a few cases with hand involvement have been reported. We report a case of Ewing's sarcoma of the left hand, presenting as a swelling of the hand gradually enlarging over six months. Plain radiographs showed marked osteolysis of the second, third and fourth metacarpals. Histological confirmation was made following biopsy. Despite amputation and post-operative chemotherapy, death occurred two months later due marrow aplasia.

[Aseptic osteonecrosis of the femoral head in thalassemia minor: a case report]. / Ostéonécrose aseptique de la tête du fémur dans la thalassémie mineure: á propos d'un cas.

We report a case of aseptic necrosis of the femoral head in a 14-year-old black adolescent with thalassemia minor disclosed by physical examination and blood tests. No other anomaly could be identified. Despite the very probably secondary nature of the aseptic osteonecrosis of the femoral head and the absence of any other etiology, it is highly difficult to demonstrate the causal effect of thalassemia minor. We reviewed the literature and discuss the pathogenesis of this association.

[Total carpometacarpal dislocation. Case report]. / La luxation carpométacarpienne antérieure complète des doigts. A propos d'un cas.

Anterior carpometacarpal dislocation are rare injuries. The anterior type is exceptional. Mr A.T 18 years old, male, student, right-handed, without pathological medical history. He was admitted in emergency after a fall of a motorbike (unknown mechanism) for a closed left hand injury; examination revealed a total impaired mobility and an important swelling of the hand without vasculonervous disorders. X-ray revealed a pure anterior dislocation of the five carpometacarpal joints. The patient was operated on in emergency using both anterior and posterior approach, which allowed to reduce the dislocation. It was maintained by K-wires. An antebrachiopalmar cast was applied for six weeks. One year later, the result obtained was considered excellent.

[Cubital tunnel syndrome and heterotopic ossification. Eight case reports]. / Syndrome du tunnel cubital et paraostéoarthropathie neurogène. A propos de huit cas.

INTRODUCTION: The occurrence of cubital tunnel syndrome during heterotopic ossification is infrequent. Entrapment of the nerve requires early decompression whereas definitive elbow release is often delayed to reduce the risk of recurrence of periarticular ossification. The pathophysiology and treatment of these two conditions are discussed. METHOD: The authors report a retrospective study of eight men (average age 37 years), all with previous head injury. The nerve entrapment was severe in two cases, moderate in four and mild in two. The elbow was ankylosed with a mean flexion deformity of 96 degrees (77 degrees-123 degrees). Management consisted of early decompression and neurolysis with anterior transposition of the ulnar nerve. In four cases elbow release was postponed until maturation of the ossification. RESULTS: The neurolysis results were assessed according to the score of KLEIMAN modified by TEOH. They were excellent in two cases, good in five and bad in one. DISCUSSION: Entrapment of the ulnar nerve in the context of heterotopic ossification seems related to compression and tension on the ulnar nerve. The compression may be due to prolonged pressure of the medial edge of the elbow on the bed of the nerve, or to a periarticular bony bridge and the initial inflammatory reaction of the heterotopic ossification. Ulnar nerve tension seems to be due to prolonged flexion of the elbow joint and to movements of the shoulder and the wrist, on either side of the ankyrozed elbow. Treatment should be by early decompression of the nerve and we recommend, in addition, anterior transposition to reduce the tension on the nerve. The elbow release can be combined with the neurolysis or delayed according to the state of activity of the heterotopic ossification.

[Ossifying parosteal lipoma of the rib: a case report]. / Lipome para-ostéal ossifiant costal: à propos d'un cas.

Ossifying parosteal lipoma is an uncommon form of parosteal lipoma. We report an exceptional rib localization where hyperosteosis probably arose from contact between the lipoma and the periosteum. Foci of metaplastic cartilage undergoing chondral ossification within the adipose tissue suggest a possible mixed origin.